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Yet, very little is known about the impact of so called \u201cearly brain injury\u201d on patents with clinically good grade SAH (as defined as World Federation of Neurosurgeons Grade 1 and 2). 27 patients with good grade SAH underwent MRI scanning were prospectively recruited at three time-points after SAH: within the first 72\u00a0h (acute phase), at 5\u201310\u00a0days and at 3\u00a0months. Patients underwent additional, comprehensive cognitive assessment 3\u00a0months post-SAH. 27 paired healthy controls were also recruited for comparison. In the first 72\u00a0h post-SAH, patients had significantly higher global and regional brain volume than controls. This change was accompanied by restricted water diffusion in patients. Persisting abnormalities in the volume of the posterior cerebellum at 3\u00a0months post-SAH were present to those patients with worse cognitive outcome. When using this residual abnormal brain area as a region of interest in the acute-phase scans, we could predict with an accuracy of 84% (sensitivity 82%, specificity 86%) which patients would develop cognitive impairment 3\u00a0months later, despite initially appearing clinically indistinguishable from those making full recovery. In an exploratory sample of good clinical grade SAH patients compared to healthy controls, we identified a region of the posterior cerebellum for which acute changes on MRI were associated with cognitive impairment. Whilst further investigation will be required to confirm causality, use of this finding as a risk stratification biomarker is promising.<\/jats:p>","DOI":"10.1038\/s41598-021-02539-x","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T06:04:42Z","timestamp":1638338682000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Early brain injury and cognitive impairment after aneurysmal subarachnoid haemorrhage"],"prefix":"10.1038","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8763-6818","authenticated-orcid":false,"given":"Matthew J.","family":"Rowland","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payashi","family":"Garry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn","family":"Ezra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rufus","family":"Corkill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jezzard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Westbrook","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwena\u00eblle","family":"Douaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle T. 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In addition, KP, MR, JW, ME and PG are named as co-inventors on a provisional UK patent application titled \u201cUse of cerebral nitric oxide donors in the assessment of the extent of brain dysfunction following injury.\u201d MR is currently funded from Feb 2021 to Feb 2022 on a Senior Clinical Research Training Fellowship with Roche. IB, RC, GD, PJ and JW report no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"23245"}}